局部进展期胃癌根治术后行同期放化疗与单纯化疗的疗效比较

Comparison of curative effect of concurrent chemoradiotherapy and chemotherapy alone in the treatment of locally advanced gastric cancer after curative gastrectomy

目的观察比较局部进展期胃癌根治术后行同期放化疗与单纯化疗的疗效。方法回顾性分析2011~2013年在本院行D2根治术、术后病理分期T（3~4）N（0~1）M0或TxN（2^3）M0期的65例胃癌患者的临床资料,其中术后同步放化疗35例、术后单纯化疗30例。比较两组患者术后辅助治疗的不良反应发生率,2年总生存率,2年无病生存率及2年远处转移率的差异。结果两组术后2年总体生存率无明显差异（82.3%vs.79.0%,P〉0.05）,但与术后单纯化疗相比,术后同步放化疗组的无病生存率增高（75.5%vs.56.7%,P〈0.05）,局部复发率降低（17.1%vs.40.0%,P〈0.05）。与术后单纯化疗组相比,术后同步放化疗组中发生3级或4级中性粒细胞减少或血小板减少发生率明显增高（40.0%vs.13.3%,P〈0.05）,3级或4级胃肠道不良反应发生率也增高（40.0%vs.16.7%,P〈0.05）。结论局部晚期胃癌根治术后同步放化疗较术后单纯化疗可以减低局部复发率及远处转移率,但总生存获益不明显,同时3级或4级不良反应明显增加。

Objective To observe and compare the efficacy of concurrent chemoradiotherapy and chemotherapy alone in the treatment of locally advanced gastric cancer after D2 radical resection. Methods From 2011 to 2013, clinical data of 65 patients with gastric cancer who underwent radical surgery,postoperative pathological stage T（3~4）N（0~1）M0 or TxN（2 ~3）M0in our hospital were analyzed retrospectively. Among them, thirty-five patients accepted postoperative chemoradiotherapy and thirty patients received postoperative chemotherapy alone. All cases were followed up for more than two years. The incidence of side effects, two year overall survival, two year disease-free survival and two year distant metastasis rate were compared between the two groups. Results There was no significant difference in the two years overall survival rate between the two groups（82.3% vs. 79%,P0.05）. The two years disease free survival（DFS） of synchronous chemoradiotherapy group was higher than that in the chemotherapy alone group（75.5% vs. 56.7%, P〈0.05）. Postoperative recurrence rate in chemoradiotherapy group was lower than that in the chemotherapy alone group（17.1% vs. 40.0%, P〈0.05）. Compared with the chemotherapy alone group, the incidence of grade 3 or grade 4 neutrophil or thrombocytopenia reduction significantly increased in patients with postoperative synchronous chemoradiotherapy. Meanwhile, the incidence of grade 3 or grade 4 gastrointestinal adverse reaction rate also increased（40.0% vs. 16.7%, P〈0.05）. Conclusions Chemoratiotherapy after radical resection for advanced gastric cancer patients may reduce relapse rate and distant metastasis rate,butthe benefit of overall survival is not obvious. At the same time, the adverse reactions of grade 3 or grade 4were significantly increased.